Publication

Abstract : Introduction: Hilar Cholangiocarcinoma (hCAA) is often incurable at diagnosis and palliative treatment is the only option for most patients. Endoscopic placement of biliary stents to facilitate bile flow forms the cornerstone of palliative therapy. Tumour ingrowth with blockage of stent continues to be a major problem. Endo- Biliary Radio Frequency Ablation (EBRA) has emerged as an adjunct to existing treatment options by potentially prolonging stent patency and survival. However the safety and efficacy of EBRA is still an area that merits further study. Methods: The study was conducted at a high volume tertiary care centre from January 2017 to December 2019 where consecutive patients of hCCA requiring endoscopic palliation were included. EBRA was performed using the ELRATM (Endo Luminal Radiofrequency Ablation) electrode from Taewoong Medical (South Korea) during the ERC, followed by the placement of a Self-expanding metallic stent (SEMS) as per protocol (Group 1). Patients who did not consent to the EBRA were treated with SEMS alone and served as controls (Group 2). The primary outcome was overall survival; while secondary outcomes studied were need for repeat interventions and procedure related adverse events. Results: A total of 49 patients were included (mean age 66.65±12.96 years, M:F=0.8). 22 patients underwent EBRA (Group 1); and 27 patients underwent SEMS placement alone (Group 2). The baseline characteristics (age, gender, bismuth staging of hCCA and post drainage palliative chemotherapy) were similar in both groups. The median survival for group 1 was 282 days and for group 2 was 180 days (p=0.008). Post procedure cholangitis was noted in 7/22 patients (31.8%) in Group 1 and 8/27 patients (30.7%) in group 2. Four patients (17.3%) in group 1 required re-stenting within 6 months while 8 patients (30.7%) required re-stenting in group 2. Conclusions: Patients who underwent EBRA were found to have a significant survival advantage as compared to standard treatment options. EBRA was found to be technically feasible, safe and can be a useful adjunct to endoscopic palliation in patients with hCCA.